Defibrillator on job training dc shock ppt.pdf

dc shock

1. WELCOME
TO
Defibrillator on job training
April 20
th ,
2022
trainer:
Mr. Jamal Naser Noori

2. What is Defibrillator?
❖A defibrillator is an electrical device that
provides a shock to the heart when there
is a life-threatening arrhythmia present.
❖It provides shock that basically shocks
the heart to stop so that it can start
rhythmically contracting again

3. CON…
❖In Ventricular fibrillation (a very rapid erratic beating
of the heart)
❖multiple parts of pacemakers in the heart starts sort
of beating erratically and the heart can't rhythmically
contract.
❖We perform defibrillation in this condition to start
heart contraction in a rhythm.

4. Types of defibrillator:
❖Monophasic Defibrillators:
A type of defibrillation waveform where a shock is
delivered to the heart from one vector.
❖Biphasic Waveforms:
A type of defibrillation waveform where a shock is
delivered to the heart via two vectors.

6. Biphasic Defibrillator
Monophasic Defibrillator (Code master)

7. The factors that determine the
thoracic impedance:
•First on it
•The selected energy
•The size of the paddles or electrodes
•Conduction of the interface between the
pallets and the skin

8. CON…
•The number of shocks previously and the time
interval between shocks
•The position of the paddles on the chest
•The pressure with paddles on the chest
•The thickness of the chest wall and obesity

9. The shockable rhythms
❖DC Shock
1.VF with out pules
2.PVT with out pules
❖Synchronous Shock
1. SVT

10. Types of defibrillator:
1. They can be automatic (Automated External
Defibrillator-AED).
2. The monophasic defibrillator:
they are no longer produced but are still in use.
They deliver a unipolar current (directed in one
direction) and therefore generally require a higher
level of energy.

11. CON…
3. The biphasic defibrillator:
they deliver a current that goes in a positive direction
and then in the opposite direction for a defined time.
The biphasic waveforms produce less post-shock
myocardial dysfunction.

12. Paddles or self and adhesives
electrodes
Paddles:
•Apply gel plates separately on the chest wall to
ensure good contact and reduce the thoracic
impedance.
•These gel plates may move during chest
compressions and must be repositioned
•Do not use: ultrasound gel, saline or alcohol
gauze, and avoid using near the EKG electrode
which can cause an electric arc.

13. CON…
Self-adhesive electrodes:
•They are safe and preferable to standards
paddles
•They can deliver faster successive shocks
during prolonged resuscitation and reduce
the duration of interruption of chest
compressions

14. Paddles or self-adhesives electrodes
position:
•Paddles must be positioned around the heart to
allow the current to pass through it.
•Under the right clavicle
•In the left axilla
•We must choose the largest possible paddles for
maximum contact with the chest wall, but they
should never be in contact each other.
•Must apply firm pressure on the paddles to ensure
good contact when delivering the shock.
•Pediatric paddles for the children < 10 kg (diameter
4.5 cm).

16. Energy dose:
1. DC Shock
•For adult 120 till 200 J DC shock
•For pediatrics 2 till 10 J/kg
2.SYNCHRONOUS
•For adult 50 till 120 J
•Pediatrics 0.5 till 2 J/kg

17. Safety rules:
•Wear gloves
•Oxygen: free sources of oxygen (oxygen
mask, ambo bag , nasal cannula…)
•Surface dry: dry the chest before the shock if
necessary
•Contact: ensure that nobody is in direct or
indirect contact with the patient (bed,
infusions…)

18. CON…
•Check that the paddles/electrodes are not in
contact with metal
•Check that the operators are familiar with the
equipment and provide clear information to
the team
•Pay attention to the positioning of the
paddles/electrodes in patients with a
pacemaker or an implantable defibrillator:
they must be placed at least 12 cm from the
pacemaker to reduce the risk of burns.

19. CARDIOVERSION
SYNCHRONOUS
❖Definition:
•This is an electrical shock causing R-wave
synchronized depolarization to avoid
administering an electrical shock during the
period of ventricular vulnerability.
•This reduces the risk of inducing VF.

20. CON…
•It is used to terminate SVT (if ADENOSINE
failure or vascular access unavailable) or to
convert stable VT with a pulse.
•The conscious patient must be sedated or
anesthetized before cardioversion.
•Activate SYNCHRONOUS MODE.
•Check that the ECG is accurate enough for the
defibrillator to detect the R-wave.